Király László, Prodán Zsolt
Department of Cardiac Surgery, Pediartic Cardiac Centre, Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary.
Croat Med J. 2002 Dec;43(6):656-9.
To present our experience with modified cannulation with continuous, moderately hypothermic systemic perfusion in extensive aortic arch repair. The technique has fewer complications and preserves cerebral blood flow autoregulation.
Nine neonates, 6 with the hypoplastic left heart syndrome and 3 with the interrupted aortic arch with ventricular septal defect, were surgically treated with this technique between June and December 2001. Before extracorporeal circulation, 3.5-mm polytetrafluoroethylene tube was sutured onto the innominate artery and the arterial perfusion cannula inserted into the tube. Aortic arch repair was then performed with extracorporeal circulation. Right radial artery and femoral artery pressures were continuously monitored. Perfusion flows were built up gradually, with strict attention to the upper body (right radial artery) pressures not to exceed normal values. Procedures were carried out at moderate hypothermia (>28 degrees C), preferably with the beating heart.
No morbidity or mortality attributable to continuous perfusion occurred. Mean+/-SD extracorporeal circulation duration was 114+/-26 min. Maximum perfusion rate (actual/required flow for body surface area) was 1.65 at normal perfusion pressures. Right radial artery pressure at full flow (2.2 L/m2/min) was 56.1+/-6.7 mm Hg, whereas femoral artery pressure was 34.2+/-8.2 mm Hg. Decrease in right radial-to-femoral artery pressure was 21.9+/-5.6 mm Hg. The lowest nasopharyngeal temperature was 28.5 degrees C. There were no neurologic complications.
Continuous, moderately hypothermic systemic perfusion via collaterals seems to be a method of choice in aortic arch repair in neonates. As there is no need for deep hypothermic total circulatory arrest, its numerous sequelae, such as increased postoperative bleeding and permanent neurologic deficit, can be avoided.
介绍我们在广泛主动脉弓修复术中采用改良插管持续中度低温全身灌注的经验。该技术并发症较少，且能保留脑血流自动调节功能。
2001年6月至12月期间，9例新生儿接受了此项技术的手术治疗，其中6例为左心发育不全综合征，3例为主动脉弓中断合并室间隔缺损。在体外循环前，将3.5毫米的聚四氟乙烯管缝合到无名动脉上，并将动脉灌注插管插入该管。然后在体外循环下进行主动脉弓修复。持续监测右桡动脉和股动脉压力。逐渐增加灌注流量，同时严格注意上身（右桡动脉）压力不超过正常值。手术在中度低温（>28摄氏度）下进行，最好是在心脏跳动的情况下。
未发生与持续灌注相关的发病或死亡情况。体外循环平均持续时间为114±26分钟。在正常灌注压力下，最大灌注率（实际/体表面积所需流量）为1.65。全流量（2.2升/平方米/分钟）时右桡动脉压力为56.1±6.7毫米汞柱，而股动脉压力为34.2±8.2毫米汞柱。右桡动脉与股动脉压力差为21.9±5.6毫米汞柱。最低鼻咽温度为28.5摄氏度。未出现神经系统并发症。
通过侧支进行持续中度低温全身灌注似乎是新生儿主动脉弓修复的一种首选方法。由于无需深低温全循环停搏，因此可以避免其众多后遗症，如术后出血增加和永久性神经功能缺损。
